Blisters or Vesicles in Atopic Dermatitis

Blisters are common in atopic dermatitis (eczema). They can come with short-term (acute) inflammation. But blisters also can be caused by other skin or health issues. In some cases of eczema, collections of blisters can be a sign of an underlying infection.^1,2

What are blisters?

Blisters are small bumps under the skin that are filled with fluid or blood. Small blisters are called vesicles. Larger blisters are called bullae.^2,3

Your skin helps keep the water in your body balanced. When the skin is damaged, irritated, or inflamed, it can start to break down. When the top layers of skin are not as strong as normal, fluid from inside your body can leak out.^2,3

If this happens and the very top layer of skin is still intact, a blister will form. If the blister is popped or the top layer of skin breaks, the fluid will come out. After the fluid comes out, the area may scab or crust over.^2,3

Some common causes of blisters are:^2,3

• Friction from scratching or wearing tight shoes
• A bacterial infection of the skin called impetigo
• Viral infections like chicken pox or herpes zoster (shingles)
• Autoimmune disorders that affect the skin barrier
• Burns like sunburns or scald burns
• Reaction to a drug
• Eczema and other causes of skin inflammation and breakdown

Why do blisters occur with eczema?

Vesicles are common in people with eczema. They are often present in acute eczema flare-ups. Small clusters of blisters are common in areas that have been recently inflamed or infected. In areas of chronic or long-term eczema, thickened skin (plaques) are more likely than blisters to occur.^1,4

In people with eczema, blisters can occur for several reasons. Eczema is caused by a weakened skin barrier and overactive immune system, which lead to skin breakdown and inflammation. Both of these can easily create blisters in affected areas.^1,4

Continuous scratching related to eczema itch can make skin breakdown worse and create more blisters. It also can cause blisters to pop and crust over.^1,4

Blisters as a sign of secondary infection

Eczema itself is not contagious. However, it does increase the risk of developing a skin infection in affected areas. Blisters on someone with eczema could be a sign of an underlying infection.^1,2

Hand, foot, and mouth disease is common in kids and is caused by the coxsackie virus. It can lead to blisters in areas where eczema is present.^1,2

It is also possible to get a herpes simplex virus (HSV) infection in areas affected by eczema. This infection is called eczema herpeticum. It is rare, but it can spread quickly and needs treatment. Symptoms include blisters that:^1,2

• Quickly arise
• Spread
• Bleed
• Form perfect, punched-out circles

If you have this type of blisters, tell your doctor as soon as possible.^1,2

Dyshidrotic eczema

Blisters are common in most cases of eczema. But there is one type of eczema that is known specifically for blisters on the hands and feet. This is called dyshidrotic eczema, or dyshidrosis.^5,6

The blisters of dyshidrotic eczema affect the fingers and toes too. This type of eczema tends to arise in people between 20 and 40 years old. It can be a reaction to:^5,6

• Certain allergens that you touch
• Chronic sweat
• Treatment with an immunoglobulin infusion called IVIG (used to treat certain immune system issues)

How are blisters treated?

Blisters caused by sunburns or friction will heal on their own. Blisters caused by eczema can be improved with good prevention and treatment. Ways to prevent and treat eczema blisters include:^1,3-7

• Wash the blistered area with non-irritating soap and water.
• Use ice to decrease swelling and pain.
• Avoid popping blisters.
• Cover blisters that burst with bandages.
• Prevent eczema flares with good skin moisturizing.
• Take all eczema treatments, including prescription creams or drugs, as your doctor prescribes them.
• Reduce stress as much as possible to prevent future flares.

If you notice blisters worsening, spreading, or developing thick yellow-white fluid (pus), talk to your doctor. You may have an infection at the blister site that needs to be treated.²

Eczema herpeticum can spread quickly and cause significant damage. It needs to be treated as soon as possible with antiviral drugs.^2,7